Substance use is a serious concern in Vermont, which has posted one of the highest overdose death rates in the country relative to its small population. Deaths have now fallen for two straight years. Key figures:

• 236 opioid-related overdose deaths in 2023, according to the Vermont Department of Health.
• 183 opioid-related overdose deaths in 2024, a 22% decrease from 2023.
• 95% of 2023 opioid-related deaths involved fentanyl, about 220 of them.
• Overdose deaths have fallen for two consecutive years after peaking in 2022.
• Heroin-only deaths dropped sharply in 2023, from 23 to 9.
• Fentanyl-related deaths are more than double the 2019 level.

Vermont’s overdose death rate is among the highest per capita in the nation. Fentanyl is now involved in nearly all opioid-related deaths, though the state has recorded two straight years of declines after a 2022 peak.

Vermont expanded Medicaid in 2014 under the Affordable Care Act, and its Medicaid program covers the full range of addiction treatment. The Vermont Department of Health oversees the addiction treatment system. Of the 49 facilities listed below, 47 accept Medicaid.